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Citation
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Winter E, Byrne JP, Hynes AM, Geng Z, Seamon MJ, Holena DN, Malhotra NR, Cannon JW. J. Trauma Acute Care Surg. 2022; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: In Philadelphia, PA, police and Emergency Medical Services (EMS) transport patients with firearm injuries. Prior studies evaluating this system have lacked reliable pre-hospital times. By linking police and hospital datasets, we established a complete timeline from firearm injury to outcome. We hypothesized that police-transported patients have shorter pre-hospital times that, in turn, are associated with improved survival and increased unexpected survivorship at 6 and 24 hours.
METHODS: This retrospective study linked patient-level data from OpenDataPhilly Shooting Victims and the Pennsylvania Trauma Systems Foundation. All adults transported to a Level I or II trauma center after firearm injury in Philadelphia from 2015-2018 were included. Patient-level characteristics were compared between cohorts; unexpected survivors were identified using TRISS. Multiple regression estimated risk-adjusted associations between transport method, pre-hospital time, and outcomes.
RESULTS: Police-transported patients (n = 977) had significantly shorter pre-hospital times than EMS-transported patients (n = 320) (median 9 minutes [IQR 7-12] vs. 21 minutes [IQR 16-29], respectively; p < 0.001). Police-transported patients were more often severely injured than those transported by EMS (60% vs. 50%, p = 0.002). After adjusting for confounders, police-transported patients had improved survival relative to EMS on hospital arrival (87% vs. 84%, respectively, p = 0.035), but not at 6 hours (79% vs. 78%, respectively, p = 0.126) or 24 hours after arrival (76% vs. 76%, respectively, p = 0.224). Compared to EMS, police-transported patients were significantly more likely to be unexpected survivors at 6 hours (6% vs. 2%, respectively, p < 0.001) and 24 hours (3% vs. 1%, respectively, p = 0.021).
CONCLUSION: Police-transported patients had more severe injuries, shorter pre-hospital times, and increased likelihood of unexpected survival compared to EMS-transported patients. After controlling for confounders, patient physiology and injury severity represent meaningful determinants of mortality in our mature trauma system, indicating an ongoing opportunity to optimize in-hospital care. Future studies should investigate causes of death among unexpected early survivors to mitigate preventable mortality. LEVEL OF EVIDENCE: Prognostic and Epidemiological, Level III.
Language: en |